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Before and After Treatment of Subacute Combined Degeneration

Hiroyuki Tomoda, MD; Hiroshi Shibasaki, MD; Ikuo Hirata, MD; Kenichiro Oda, MD

Arch Neurol. 1988;45(5):526-529.

Abstract
• Central and peripheral nerve conduction was studied in two patients with subacute combined degeneration by using the short-latency somatosensory evoked potentials and the peripheral nerve conduction study during treatment with cyanocobalamin. Before the treatment, somatosensory evoked potentials with median nerve stimulation were normal, but those with peroneal nerve stimulation revealed prolonged central conduction indicating dysfunction within the posterior column. Peripheral sensory and motor nerve action potentials were reduced with normal or slightly reduced conduction velocity. After treatment, marked shortening of the central conduction time (by 24% and 31%, respectively) was observed with mild or no recovery of peripheral nerve action potentials. These physiologic findings suggest that the main pathologic changes in the central nervous system may be demyelination in the posterior column in addition to axonal degeneration in the peripheral nerve. The former was responsive to treatment but the latter was poorly responsive to treatment. Sensory symptom in subacute combined degeneration appears to be, at least partially, attributed to the spinal cord lesion.

Author Affiliations
From the Department of Internal Medicine (Division of Neurology), Saga (Japan) Medical School. Dr Tomoda is now with the Department of Neurophysiology, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

Footnotes
Accepted for publication Sept 10, 1987.

Reprint requests to Division of Neurology, Department of Internal Medicine, Saga Medical School, Nabeshima, Saga 840-01, Japan (Dr Shibasaki).

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